AJM onlineClinical research studyCharacteristics, Symptoms, and Outcome of Severe Dysnatremias Present on Hospital Admission
Section snippets
Materials and Methods
All patients in whom serum sodium was measured at the department of emergency medicine of a university hospital between April 1, 2008, and March 30, 2011, were included in this retrospective study. In patients who were admitted to the emergency department more than once, only the first admission was considered for the analysis.
Hyponatremia was defined as a serum sodium level less than 135 mmol/L, and hypernatremia was defined as a serum sodium level greater than 145 mmol/L. Severe hyponatremia
Results
Between April 1, 2008, and March 30, 2011, a total of 77,847 patients were admitted to the emergency department. Serum sodium was determined in 43,911 patients. The mean age of patients was 53 years (standard deviation, 20); 18,685 (43%) were women, and 25,226 (57%) were men. Hyponatremia (serum sodium < 135 mmol/L) was found in 4503 patients (10%), and hypernatremia (>145 mmol/L) was found in 678 patients (2%). The lowest serum sodium measured was 97 mmol/L, and the highest serum sodium
Discussion
Dysnatremias were present in 12% of all patients who were admitted to the emergency department. Symptoms were more common in hyponatremic patients than in hypernatremic patients. A significant proportion of patients did not receive corrective measures. Corrective measures were not more rapid in patients with symptomatic dysnatremias. A further increase in serum sodium was even observed in patients with symptomatic hypernatremia in the first 24 hours after admission.
Lee et al12 reported that 4%
Conclusions
Dysnatremias are common in patients presenting to the emergency department. Approximately one third of patients with severe hypernatremia and two thirds of patients with hyponatremia present with neurologic symptoms due to the electrolyte disorder. Symptomatic dysnatremias are not corrected faster than asymptomatic dysnatremias, although clear recommendations exist for this.
References (26)
- et al.
Hypernatremia in the critically ill is an independent risk factor for mortality
Am J Kidney Dis
(2007) - et al.
Hyponatremia in the emergency department
Am J Emerg Med
(2000) Neuromuscular manifestations of electrolyte disorders
Am J Med
(1982)Age and gender as risk factors for hyponatremia and hypernatremia
Clin Chim Acta
(2003)- et al.
Tonicity balance in patients with hypernatremia acquired in the intensive care unit
Am J Kidney Dis
(2009) - et al.
Hypernatremia
N Engl J Med
(2000) - et al.
Incidence and prognosis of dysnatremias present on ICU admission
Intensive Care Med
(2010) - et al.
Intensive care-acquired hypernatremia after major cardiothoracic surgery is associated with increased mortality
Intensive Care Med
(2010) - et al.
The epidemiology of intensive care unit-acquired hyponatraemia and hypernatraemia in medical-surgical intensive care units
Crit Care
(2008) - et al.
Characterization of intensive care unit acquired hyponatremia and hypernatremia following cardiac surgery
Can J Anaesth
(2010)
Association between hypernatraemia acquired in the ICU and mortality: a cohort study
Nephrol Dial Transplant
Hyponatremia
N Engl J Med
Hyponatremia: a prospective analysis of its epidemiology and the pathogenetic role of vasopressin
Ann Intern Med
Cited by (104)
The feasibility of emergency department observation units in the management of mild to moderate hyponatremia
2024, American Journal of Emergency MedicineDisorders of Sodium
2023, Emergency Medicine Clinics of North AmericaHyponatremia Demystified: Integrating Physiology to Shape Clinical Practice
2023, Advances in Kidney Disease and HealthHyponatremia in the emergency department
2022, American Journal of Emergency MedicineCitation Excerpt :Variations of up to four mmol/L between point-of-care and central laboratory measurements may be less important for diagnosis but are unacceptable for serial measurements during course of correction [6,7]. In patients presenting to the emergency department (ED), prevalence of hyponatremia varies between 3% and 10%, probably depending on the setting and demographics of the local population [2,8]. In special patient populations such as the elderly, hyponatremia was even more common at presentation to the ED [9].
Funding: None.
Conflict of Interest: None.
Authorship: All authors had access to the data and played a role in writing this manuscript.